Healthcare Provider Details

I. General information

NPI: 1417686528
Provider Name (Legal Business Name): MISS SARAH GRACE STEADMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 ABRAMS RD
DALLAS TX
75214-2000
US

IV. Provider business mailing address

3000 MOUNTAIN CREEK PKWY
DALLAS TX
75211-6700
US

V. Phone/Fax

Practice location:
  • Phone: 469-906-6372
  • Fax:
Mailing address:
  • Phone: 325-513-3244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB777616
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: